Some down-ticket candidates may be running away from the Romney/Ryan budget, but Senator By Appointment Only™ Dean Heller (R-NV) isn’t one of them.

“The Fix surveyed Senate candidates in some top races — a few of which we highlighted Monday as states where Ryan’s V.P. nomination and his proposal to turn Medicare into a voucher program could matter. A couple of candidates in blue-leaning states have balked at tying themselves to Ryan, while Sen. Dean Heller (R-Nev.), Rep. Denny Rehberg (R-Mont.), and Rep. Rick Berg (R-N.D.) said they would welcome Ryan to the trail.” [WaPo]

“While Senator Dean Heller may be ‘proud’ to have voted twice to end Medicare by turning it over to private insurance companies, nothing makes me prouder than standing up for the Nevada seniors depending on their Social Security and Medicare to be there when they retire,” said U.S. Senate candidate Shelley Berkley. ”Unfortunately, with Mitt Romney and Paul Ryan on the presidential ticket — and one of their biggest supporters, Dean Heller, seeking a US Senate seat, — Medicare is facing its biggest threat since its creation in 1965. The Heller-Ryan-Romney plan would dismantle Medicare by putting private insurance company bureaucrats in between patients and their doctors while increasing premiums by $6,000 a year. These are the wrong priorities for Nevada’s middle-class and seniors.”

There appears to be a bifurcated GOP assault on the popular Medicare program, one line of argument proposes that Medicare is “going broke” and it must be “reformed” to sustain it, and the other asserts that the Obama Administration has “cut” some $7 billion from the program and the Romney/Ryan Plan will “save” it. There are several words in quote marks in this paragraph because the Republican talking points are massaged to the point of obfuscation.

The Broken Back Argument: First, one of the heaviest fiscal pressures on the Medicare program is the prescription drug segment, or Part D. The Medicare Modernization Act of 2003 established Part D, but with a significant provision favorable to the pharmaceutical industry: The Department of Health and Human Services was forbidden to negotiate with the drug manufacturers for lower prices. Former Nevada Representative Jim Gibbons (R-NV2) voted in favor of H.R. 1 (June 27, 2003) at 2:33 in the morning. [roll call 332] The controversial bill passed in questionable procedural circumstances, and didn’t clear all the legislative hurdles until November 2003.

In January 2007 Nevada Representative Dean Heller had the opportunity to improve the MMA when a bill came to the floor of the House to allow the Department of Health and Human Services to negotiate with the pharmaceutical manufacturing corporations for lower prescription drug prices. Representative Heller voted NO on H.R. 4, January 12, 2007 on roll call vote 23.

It really doesn’t quite do to argue that Medicare must be restructured as a voucher program to “save” it when measures which were intended to reduced the costs, such as allowing negotiated drug prices, were rejected by the Republicans, including Representative Heller, in the 110th Congress.

Cuts and Savings: The popular flaming pants theme du jour is that Medicare must be ‘saved’ and the Romney/Ryan voucher program is the way to accomplish this end. The issues here are both substantive and semantic.

The Republican National Committee issued its talking point guidelines for down-ticket candidates: “Do not say: ‘entitlement reform,’ ‘privatization,’ ‘every option is on the table,’” the National Republican Congressional Committee said in an email memo. “Do say: ‘strengthen,’ ‘secure,’ ‘save,’ ‘preserve, ‘protect.’” [Politico]

One talking point alleges that Medicare must be ‘saved’ because the Affordable Care Act supposedly cut $500 billion* from Medicare. The RNC may not wish to have the public analyze this contention too carefully. A little scrutiny demonstrates that the $500 billion reduction in the ACA comes from reducing taxpayer subsidies to health insurance corporations as a inducement to offer highly profitable Medicare Advantage insurance policies. Other savings are gained by reducing waste, fraud, and abuse of the Medicare program. It is very important to know that the $700 billion in savings DO NOT AFFECT ANY MEDICARE COVERAGE FOR THE ELDERLY.

On the other hand, the Romney/Ryan budget maintains the same numbers, “The Ryan budget assumes that very same $500 billion cut. Well, “cut” isn’t the right word; “savings” is more accurate. The reality is that in real dollars, Medicare spending will keep rising — just not by as much.” [NPR] The difference is that in the Affordable Care Act the savings are returned to the Medicare program, in the Romney/Ryan Budget plan the savings are used to protect lower tax rates for the 1%.

He Got The Memo

We should notice that Senator Heller got the RNC memo, note the “strengthens Medicare” language below:

“Dean believes the current health care law should be replaced with a plan that expands access and lowers costs for businesses, allows for purchasing of insurance across state lines, strengthens Medicare, protects individuals with pre-existing conditions and high medical costs, and preserves the doctor-patient relationship.” [Heller]

There is a bit of code to be translated in this campaign rhetoric. One way to lower costs for businesses is to simply require that all health insurance be procured by individuals, or to put it another way — no incentives should be offered businesses to provide health insurance benefits. The ACA includes tax breaks for small businesses to encourage and assist in the inclusion of health care benefits for their employees. Repealing the ACA would remove these tax credits.

The insurance corporations have long wanted the across state lines provisions because if enacted this would allow the corporations to offer policies based on the least restrictive regulatory environment. If State X did NOT include basic coverage for immunizations, pre-natal care, cancer screenings, mental health care, or autism screening and coverage, then States Y and Z would have to drop their requirements that these elements be covered in their states.

Here comes the memo language: strengthens Medicare. The Romney/Ryan proposal would ‘strengthen’ Medicare only so far as it transforms it from the current system into one in which senior citizens are supposed to shop for individual insurance plans and the health insurance corporations would be subsidized by taxpayers in the from of vouchers. A reality check from the Berkley camp:

“In April 2011, Heller voted for the House Republican budget blueprint drafted by Paul Ryan, H Con Res 34, that the Wall Street Journal said “would essentially end Medicare.” According to the Associated Press, “The GOP proposal passed 235-193, with every Democrat voting “no.” The nonbinding plan lays out a fiscal vision cutting $6.2 trillion over 10 years from the budget submitted by President Barack Obama. It calls for transforming Medicare from a program in which the government directly pays medical bills into a voucher-like system that subsidizes purchases of private insurance plans.” [Berkley]

In short, the Romney/Ryan plan so enthusiastically endorsed by Senator Heller is a reversion to the pre-Medicare system in which individuals 65 and over would be required to shop for insurance plans on their own, only this time there’s a bonus voucher for the health insurance corporations. There are a couple of problems with all this “individual choice.”

Having personal choices makes for a lovely campaign sound bite, but in the real world elderly Americans would face some of the same practical problems consistently faced by anyone trying to buy health insurance policies. (1) There may be no real competition between or among health insurance companies in specific geographical regions. (2) Insurance corporations would be allowed to sell junk policies with artificial lifetime limits on coverage. (3) Insurance corporations would be free to restrict patient access to medical service providers outside their group.

Not to put too fine a point to it, but the insurance corporations would be the ones inserted between a patient and his or her physician — unlike the current Medicare (ACA) system in which the patient is free to choose among any health care provider accepting patients.

It appears that the GOP has given up trying to attack the Democratic argument that pre-existing conditions were abused by the insurance industry to arbitrarily rescind policies for vacuous, but profitable, reasons.

Small businesses should be offered no incentives to offer health care plans for their employees and should be free to eliminate such coverage, thus requiring that each individual purchase a his or her own insurance policy.

Insurance corporations should not have to follow guidelines for basic coverage which provides for any medical condition or treatment not offered in the state having the least requirements.

Health insurance corporations should be free to devise plans which have artificial limits on lifetime coverage, which restrict patient choice to health care providers associated with the health insurance corporation, and which have no limits on policy premiums for senior citizens.